Case Study

Hepatocellular carcinoma with abscess in a 14 year old MN Labrador Retriever dog

A 14-year-old MN Labrador Retriever dog was presented from the RDVM for abdominal ultrasound for evaluation of acute onset collapse, lateral recumbency, abdominal pain, vomiting, and hematuria. On physical examination the patient was febrile, heart and lung sounds were clear on auscultation, he was non-ambulatory and weak, the abdomen was painful, and the mucous membranes were pink and tacky. Abnormalities on CBC and blood chemistry were elevated MCV, lymphopenia, thrombocytopenia, hyperproteinemia, hyperalbuminemia, markedly elevated ALT activity, and hyperbilirubinemia.

A 14-year-old MN Labrador Retriever dog was presented from the RDVM for abdominal ultrasound for evaluation of acute onset collapse, lateral recumbency, abdominal pain, vomiting, and hematuria. On physical examination the patient was febrile, heart and lung sounds were clear on auscultation, he was non-ambulatory and weak, the abdomen was painful, and the mucous membranes were pink and tacky. Abnormalities on CBC and blood chemistry were elevated MCV, lymphopenia, thrombocytopenia, hyperproteinemia, hyperalbuminemia, markedly elevated ALT activity, and hyperbilirubinemia. VPC’s were evident on EKG. On survey abdominal radiographs a radiopaque, soft, circular opacity was present in the caudal abdomen. The patient was treated with lidocaine, intravenous fluids, analgesics, and antibiotics.

DX

Hepatocellular carcinoma with gas penetration and bacterial rods.

Sonographic Differential Diagnosis

Cholangiohepatitis with lobar mineralization and gas penetration. Potential for neoplasia.

Image Interpretation

The left medial liver reveals multifocal gas or mineralization within the bile ducts. Coarse parenchyma and echogenic inflammation is present in surrounding tissues. The gallbladder is also thick and echogenic suggestive for chronic cholecystitis.

Outcome

Further assessment and therapy recommended was urinalysis, urine culture and sensitivity, plasma transfusions, CRI of lidocaine, and exploratory surgery due to the possibility of upper gastrointestinal perforation or perforating foreign body was performed. Full left lobectomy was performed owing to the mass with gas penetration.

Clinical Differential Diagnosis

GI pathology: obstruction/perforation/neoplasia, peritonitis; Pancreatic pathology: pancreatic disease – pancreatitis/abscessation/neoplasia; liver abscessation